A non-governmental organisation, Health Place for Children Initiative (HPCI), has established a five-bed Pediatric Intensive Care Unit (PICU) at the University of Nigeria Teaching Hospital (UNTH) in Enugu State.
The founder of HPCI, Dr. Odiraa Nwankwo, who is a Clinical Assistant Professor of Pediatrics at the Sidney Kimmel Medical College at Jefferson University Philadelphia, said they had assembled the required equipment/devices and supplies valued at above $250,000.00, and had strong support from the hospital leadership under Dr. Obinna Onodugo, the Chief Medical Director.
According to him, “in September 2019, we will begin the initial phase of training of healthcare providers and biomedical personnel. Prof. Tagbo Oguonu, the head, Children Emergency Room, is our clinical anchor for the project.
“Despite improved immunisation, the under-5 mortality ratio is still high, both in Nigeria and other sub-Saharan African countries. Data from the Nigerian Demographic Health Survey (NDHS) in 2013 suggests that one out of every eight children born in Nigeria will die before their fifth birthday. Majority of the causes of these high mortality rates are either preventable or reversible.
“For Nigeria to achieve the 2030 Sustainable Development Goal (SDG) 3.2, a smart comprehensive approach that includes improved immunisation, health promotion, and provision of prompt acute and critical care services should be promptly adopted. However, the provision of critical care services in organised PICU is either rudimentary or non-existent in many low and middle income countries.”
He expressed sadness that in Nigeria, if a child is in respiratory distress/failure and goes to an emergency room at most of the teaching hospitals, “they do not have the capacity to incubate and mechanically ventilate the child.
“This is a pilot project, with the goal to upscale to other teaching hospitals in Nigeria. We hope to establish at least one Pediatric ICU at a major teaching hospital in each of the six geo-political regions in Nigeria by the end of 2023, applying the UNTH model.”
He however said having a PICU in low-resourced setting will require five essential elements, which include: assembling of equipment/devices and medical supplies; training of healthcare providers (doctors, nurses, and respiratory therapists etc.); strong support from the hospital leadership; establishing a pipeline/system of maintenance of the equipment for sustainability and a dedicated financial structure to sustain the clinical operation in the ICU.
According to him, the structure of the programme goes thus: a 3-year programme starting September 2019- August 2022 and an initial training in September 2019 with pre- and post-training assessment using either the Paediatric Fundamental Critical Care Support (PFCCS) Course of the Society of Critical Care (SCCM) or the BASIC Course through the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS).
Also, six structured training sessions, including two sessions every year. Each session would include series of lectures, skill stations, mock codes etc.
According to Dr. Nwankwo, who is also a Paediatric Intensivist at the Alfred I. DuPont Hospital for Children, Wilmington Delaware and Cooper University Hospital, Camden New Jersey, USA, the expected results include improvement in paediatric critical care delivery among the trained doctors, nurses and other health care workers at UNTH; a functional PICU that meets the health needs of the local communities; and expected improvement in defined outcome measures.
Others are replication of this model in other tertiary pediatric centres in Nigeria; development of clinical guidelines and protocols in collaboration with the Paediatric Association of Nigeria and the Critical Care Society of Nigeria; and exploring opportunities to collaborate with peers in data collection and sharing in a safe manner. This will help to support best and evidence-based practices.